“We’ve come out of this,” says Keeling, “with 193 governments committing to create change. Now we have to hold their feet to the fire.” She also stated that, “The private food industry was pushing back, we’re already in a train wreck.” And that, “There aren’t many time-bound commitments in the new declaration.”

Hope and disappointment were Keeling’s take-aways about how much the summit may cause governments to lessen the tide of the four non-communicable diseases — cancer, cardiovascular disease, diabetes and chronic respiratory diseases — that account for 63 percent of the world’s deaths today and are undermining our global health, social and economic development and financial prosperity.

Here’s an inside view, from Keeling, of what actually happened and what still needs to happen.

Q: What issue did most everyone at the summit agree needed to happen, and happen fast?

Ann Keeling: Prevention. Almost everyone agreed on the need to step up to and put tobacco control measures in place, including taxation on tobacco to deter people from smoking.

There’s also a lot of understanding now that getting essential medicines to people is a matter of human rights. Probably 100 million people have no access to medicines they need. There’s less understanding about how we’re going to do this, but that’s where the NCD Alliance comes in. Our commitment is to push things forward and make sure the agreements made don’t get lost.

Q: What issue do you wish had found more agreement?

AK: Unfortunately, there wasn’t unanimous agreement on regulating the content of our food. The private food industry doesn’t want regulation, they want voluntary measures. But there was immediate agreement on reducing trans fat.

Q: Given that the U.S., Europe and Canada were stalling on commitments before the summit, what was the mood in the room?

AK: It was a very powerful feeling of shared concerns. I used to work for the U.N., and I’ve seen governments come to meetings mostly for show and tell — you know, to brag. But what we heard at this meeting was governments, one after the other, saying, “We’ve got this problem and we need to do something.” We didn’t hear governments saying we’ve got it all under control or we know the solution. Nor was anyone strutting around saying, “This is your problem over there.” There was a sense that this is everybody’s problem, and we’re all looking for solutions, and we’re open to finding them wherever they come from.

Q: What outcomes from the summit are you most excited about?

AK: First, we didn’t know what the level of participation was going to be. There was a lot more energy and a lot more commitments from governments than we expected. Thirty-four ministers were present, compared to the AIDS/HIV summit in 2001, where only 19 attended. Also, we had to extend the hours of the meeting because twice the number of countries than expected wanted to speak.

What was really important about this meeting is that for the first time people in government got to hear what other countries are saying on these issues. As a non-governmental organization (NGO), the Alliance can speak to governments, but what really influences them is when they hear it from another government. Also, high-income country governments got to hear their African counterparts say NCDs is an important issue for them, and they needed to hear that.

We’re excited about the strength of the language that’s now in the declaration. We’ve been saying for years that there’s an urgent problem that’s out of control, and that we haven’t got enough resources. Something needs to be done. Universal access to medicine and technology is a human right and now, for the first time, we have in our hands a document that 193 governments signed off on.

We’re pleased they committed to putting national NCD plans in place by 2013 and to come back in 2014 for a high-level review. That means they can’t take their eyes off the ball, and we’ll be watching them. We can hold their feet to the fire to make sure their plans are costed, coordinated and have resources behind them.

Q: Were there any actions committed to reduce the incidence of diabetes?

AK: No. The big disappointment is we wanted to hear, “We will commit to doing ‘X’ by this date,” but right now there aren’t many of those time-bound commitments and targets in the declaration. What we have is some very strong statements and commitment to get their targets by the end of 2012.

Q: How will the NCD Alliance ensure that commitments are kept?

AK: First, we’ll be working very early on with Margaret Chan, Director-General of WHO, to make sure the targets are what’s needed, are realistic and that they’re not just window dressing.

One important commitment made was to a follow-up-partnership. It’s too easy for people to walk away from these meetings and not take immediate action. Then people don’t see any difference on the ground, and they get cynical. For instance, I can easily imagine our diabetes member states saying, “You all went off to New York for a big meeting, but there’s no difference in my country.”

So we’ll need to see a difference within six to 12 months on the ground, and we think the follow-up-partnership will be the mechanism to drive that. The 193 uncoordinated governments can’t do this alone. We want to get the partnership up by Christmas, so it’s in full operation by 2012.

Also, we need to get the private sector involved, they need to be a part of the solution, just as they were with HIV/AIDS.

The NCD Alliance will be going out to our member association and supporting them to reflect the declaration just made back to their government and say, “Here’s the promise you made.”

And you can’t discount the power of people spreading the message and supporting each other. When those with the disease themselves become more vocal and expressed their anger in the way that the HIV/AIDS community did, things happened. We’re working on ways to support the social media space, for example, to get information to bloggers in China.

Q: What is going to have to happen to get the food industry to make changes to help contain obesity and diabetes?

AK: That’s going to be a slower evolution, so I think these changes are first going to depend on the will of the people and governments. European governments will find it much easier to regulate this than under the U.S. political system. And many low-income country governments will find it hard to regulate. They’ll find it hard to resist pressure, and they’ll also have to pay for laboratories to test food content. The technical aspect will be huge, it’s not just a matter of political will. But it has started, and it will also depend on the public getting involved.

Part of our role will be to spread greater understanding among the public, particularly to women. Women will act when they understand the impact of some of these foods on their children and their future.

Q: So you see a grassroots movement necessary to create a change in our food supply?

AK: Yes, it has to be. I think that’s what will also drive governments. Not everybody is aware of the long-term consequences of what our kids are eating, of their sedentary lifestyles or the dangers of childhood obesity.

It’s great that people in the media and in the blogosphere are taking up the cause. Wouldn’t it be great if we all took this declaration to the Obamas and said, “Well, you didn’t turn up for the summit, but here’s what the government agreed to on your behalf.” This is exactly the First Lady’s agenda.

Q: With failing economies around the world, is there much that can be done without spending a lot of money?

AK: We absolutely can do things now and get a return now, and it doesn’t have to cost a lot of money. Some of the work being done in New York City already, like eliminating trans fats, shows that if you take action now you can save money, save lives, improve health and see improvements within one year.

It’s also about individuals changing their lifestyle, which doesn’t require a lot of money. We need to get individuals thinking about their own health, and what they can do. People can add 10 minutes of exercise to a day and know the warning signs of diabetes, for example. If people invest just a small amount of time on their health and their children’s health, it won’t cost much money — but it will save a lot of lives and a lot of misery.

Q: Do you think there’s still time to turn the skyrocketing incidence of NCDs around before we end up in a train wreck?

AK: We’re already in a train wreck, and yes we can turn this thing around, but there’s not much time. Our latest diabetes figures show there are 366 million people in the world with diabetes now, and that will be well over half a billion within a generation. Unless we do something, nothing much is going to stop that.

So we’re already there. But the good thing is at the summit, governments got the message that we’re there. They also got the message that there is something we can do about it. It’s not as though we need to shut our eyes to this train wreck because there’s nothing we can do. There’s plenty we can do, especially as in the case of diabetes with lifestyle changes.

We started off with many things we would have liked to accomplish at the summit: more targets, more time frames, a stronger document. But we’ve come out of this with enough to be able to say we now have leadership from governments committing to create change. Now it’s societies role to make sure their governments follow their commitments.

Those who follow me on Facebook saw me litter my page this week with a bunch of screen shots from Dr. Mark Hyman's "The Fat Summit." I'll say right now,…

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Stoyan

I think in a way it is what most people expect from UN summits in general. Some promising talk, but little in the way of concrete plans and driven plans of action. From the diabetes side, it is a bit disappointing that we did not get much information at all on proposed changes. There is talk about encouraging people to live a healthier lifestyle, which is nice, but that doesn’t address the problems for people currently living with the disease. It goes to show I think that the people that really make the difference is the diabetes community itself.

The Diabetes Media Foundation (DMF) is a 501(c)(3) tax-exempt nonprofit media organization, registered in New York and the IRS, under EIN #46-3338815. DMF is devoted to informing, educating, and generating community around, living a healthy life with diabetes.